<%@ Page Language="VB" MasterPageFile="~/MasterPage.master" AutoEventWireup="false" 
CodeFile="Add_IInfo.aspx.vb" Inherits="New_Business_Add_IInfo" title="Add_IInfo" %>
<%@ Register Assembly="AjaxControlToolkit" Namespace="AjaxControlToolkit" TagPrefix="ajaxToolkit" %>

<asp:Content ID="Content1" ContentPlaceHolderID="ContentPlaceHolder1" Runat="Server">
    <table border="0" cellpadding="0" cellspacing="0" width="800">
        <tr><td style="font-size: 3px;height: 5px;"></td></tr>
    </table>
    
    <table border="0" cellpadding="0" cellspacing="0" width="800">
        <tr>
        <td align="left" style="font-weight: bold; font-size: 10pt; font-family: Arial;">
            Policy # - 2165160606
        </td>
        <td></td>
        </tr>
        <tr>
        <td align="left" style="font-weight: bold; font-size: 10pt; font-family: Arial;">
            Friends Provident - Premiere
        </td>
        <td align="right" style="font-weight: bold; font-size: 10pt; font-family: Arial; color: #d63007;">
            Add New Insured
        </td>
        </tr>
    </table>

    <table border="0" cellpadding="0" cellspacing="0" width="800">
        <tr><td style="font-size: 3px; background-color: #105BA4; height: 3px;"></td></tr>
    </table>
    
    <br />

    <table border="0" cellpadding="0" cellspacing="0" width="800">
    
    <tr>
    <!-- Start Menu -->
    <td style="width: 200px" valign="top">
    
        <table border="0" cellpadding="0" cellspacing="0" width="100%">
        <tr>
            <td style="height: 30px"><img src="../images/redT.PNG" alt="selected" />
            </td>
            <td style="font-weight: bold; font-size: 10pt; font-family: Arial; color: Black; width: 180px; height: 30px;" align="right">
            <asp:LinkButton ID="Main_Info_btn" runat="server" Font-Underline="False" 
                    ForeColor="Black">Main Information&nbsp;&nbsp;</asp:LinkButton>
            </td>
        </tr>
        <tr>
            <td style="height: 30px"><img src="../images/grayT.PNG" alt="selected" />
            </td>
            <td style="font-weight: bold; font-size: 10pt; font-family: Arial; color: #999999; width: 180px; height: 30px;" align="right">
            <asp:LinkButton ID="Other_Info_btn" runat="server" Font-Underline="False" 
                    ForeColor="#999999">Other Information&nbsp;&nbsp;</asp:LinkButton>
            </td>
        </tr>
        <tr>
            <td style="height: 30px"><img src="../images/grayT.PNG" alt="selected" />
            </td>
            <td style="font-weight: bold; font-size: 10pt; font-family: Arial; color: #999999; width: 180px; height: 30px;" align="right">
            <asp:LinkButton ID="Correspondence_btn" runat="server" Font-Underline="False" 
                    ForeColor="#999999">Correspondence&nbsp;&nbsp;</asp:LinkButton>
            </td>
        </tr>
        <tr>
            <td style="height: 30px"><img src="../images/grayT.PNG" alt="selected" />
            </td>
            <td style="font-weight: bold; font-size: 10pt; font-family: Arial; color: #999999; width: 180px; height: 30px;" align="right">
            <asp:LinkButton ID="Attachments_btn" runat="server" Font-Underline="False" 
                    ForeColor="#999999">Attachments&nbsp;&nbsp;</asp:LinkButton>
            </td>
        </tr>
        <tr>
            <td style="height: 30px"><img src="../images/grayT.PNG" alt="selected" />
            </td>
            <td style="font-weight: bold; font-size: 10pt; font-family: Arial; color: #999999; width: 180px; height: 30px;" align="right">
            <asp:LinkButton ID="Risk_Profile_btn" runat="server" Font-Underline="False" 
                    ForeColor="#999999">Risk Profile&nbsp;&nbsp;</asp:LinkButton>
            </td>
        </tr>        
        </table>
    
    </td>
    <!-- End Menu -->
    
    <!-- Start Content -->
    <td style="width: 600px">
    
        <table border="0" cellpadding="0" cellspacing="0" width="100%" style="background-color: #f2f3f5">
        <tr><td>        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 110px; height: 10px;" align="left"></td>
            </tr>
            </table>
        </td></tr>        
        
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 105px; height: 28px;" align="left">
                    &nbsp;Name:</td>
                <td style="width: 490px; height: 28px;" align="left">
                    <asp:DropDownList ID="Salutation" runat="server" Width="64px">
                    </asp:DropDownList><asp:TextBox ID="LastName_txt" runat="server" Width="124px">Acero</asp:TextBox><asp:TextBox ID="FirstName_txt" runat="server" Width="158px">William</asp:TextBox><asp:TextBox ID="MiddleName_txt" runat="server" Width="124px">Dy</asp:TextBox>
                </td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 106px; height: 28px;" align="left">
                    &nbsp;Alias:</td>
                <td align="left" style="height: 28px">
                    <asp:TextBox ID="Alias_txt" runat="server" Width="188px"></asp:TextBox></td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 108px; height: 28px;" align="left">
                    &nbsp;Marital Status:</td>
                <td style="width: 190px; height: 28px" align="left">
                    <asp:DropDownList ID="MaritalStatus_cmb" runat="server" Width="194px">
                    </asp:DropDownList></td>
                <td style="font-size: 10pt; font-family: Verdana; width: 105px; height: 28px;" align="left">
                    &nbsp;Gender:</td>
                <td style="width: 195px; height: 28px" align="left">
                    <asp:DropDownList ID="Gender_cmb" runat="server" Width="190px">
                    </asp:DropDownList>
                </td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 107px; height: 28px;" align="left">
                    &nbsp;Date of Birth:</td>
                <td style="width: 190px; height: 28px" align="left">
                    <asp:TextBox ID="Birthdate_txt" runat="server" Width="188px"></asp:TextBox>
                </td>
                <td style="font-size: 10pt; font-family: Verdana; width: 105px; height: 28px;" align="left">
                    &nbsp;Place of Birth:</td>
                <td style="width: 195px; height: 28px" align="left">
                    <asp:TextBox ID="Birthplace_txt" runat="server" Width="184px"></asp:TextBox></td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 110px; height: 10px;" align="left"></td>
            </tr>
            </table>
        </td></tr>                
        </table> 

        <table border="0" cellpadding="0" cellspacing="0" width="100%" style="background-color: #e9e9e9">
        <tr><td style="width: 601px">
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 110px; height: 28px;" align="left">
                    &nbsp;Address:</td>
                <td style="width: 190px; height: 28px" align="left">
                    <asp:TextBox ID="Add1_txt" runat="server" Width="188px">No., Street, Floor, Bldg.</asp:TextBox>
                </td>
                <td style="width: 299px; height: 28px" align="left">
                    <asp:TextBox ID="Add2_txt" runat="server" Width="288px">Brgy., Village, Area, District</asp:TextBox>
                </td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td style="width: 601px">
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 106px; height: 28px;" align="left">
                    &nbsp;City:</td>
                <td style="width: 190px; height: 28px" align="left">
                    <asp:DropDownList ID="City_cmb" runat="server" Width="194px">
                    </asp:DropDownList>
                </td>
                <td style="font-size: 10pt; font-family: Verdana; width: 105px; height: 28px;" align="left">
                    &nbsp;Country:</td>
                <td style="width: 195px; height: 28px" align="left">
                    <asp:DropDownList ID="Country_cmb" runat="server" Width="190px">
                    </asp:DropDownList>
                </td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td style="width: 601px">
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 106px; height: 28px;" align="left">
                    &nbsp;Zip Code:</td>
                <td style="height: 28px" align="left">
                    <asp:TextBox ID="Zip_txt" runat="server" Width="188px"></asp:TextBox>
                </td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td style="width: 601px">
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 105px; height: 28px;" align="left">
                    &nbsp;Nationality:</td>
                <td style="width: 190px; height: 28px" align="left">
                    <asp:TextBox ID="Nationality_txt" runat="server" Width="188px"></asp:TextBox></td>
                <td style="font-size: 10pt; font-family: Verdana; width: 105px; height: 28px;" align="left">
                    &nbsp;Residency:</td>
                <td style="font-size: 10pt; font-family: Verdana; width: 195px; height: 28px;" align="left">
                    <asp:TextBox ID="Residence_txt" runat="server" Width="112px"></asp:TextBox>
                    (in years)
                </td>
            </tr>
            </table>
            
        </td></tr>
        </table> 
            
        <table border="0" cellpadding="0" cellspacing="0" width="100%" style="background-color: #f2f3f5">
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 110px; height: 10px;" align="left"></td>
            </tr>
            </table>
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 106px;" align="left">
                    &nbsp;Telephone No:</td>
                <td style="width: 45px" align="center"><asp:TextBox ID="T1_txt" runat="server" Width="40px">63</asp:TextBox></td>
                <td style="width: 40px" align="center"><asp:TextBox ID="T2_txt" runat="server" Width="32px">000</asp:TextBox></td>
                <td style="width: 60px" align="center"><asp:TextBox ID="T3_txt" runat="server" Width="56px">0001222</asp:TextBox></td>
                <td style="width: 45px" align="center"><asp:TextBox ID="T4_txt" runat="server" Width="40px">000123</asp:TextBox></td>
                <td style="width: 300px">&nbsp;</td>
            </tr>
            <tr>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 106px;">
                    &nbsp;</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 45px;" align="center" valign="top">
                    Country</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 40px;" align="center" valign="top">
                    Area</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 60px;" align="center" valign="top">
                    Phone No</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 45px;" align="center" valign="top">
                    Ext</td>
                <td style="width: 300px">&nbsp;</td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 106px; height: 12px;" align="left">
                    &nbsp;Mobile No:</td>
                <td style="width: 45px; height: 12px;" align="center"><asp:TextBox ID="M1_txt" runat="server" Width="40px">63</asp:TextBox></td>
                <td style="width: 40px; height: 12px;" align="center"><asp:TextBox ID="M2_txt" runat="server" Width="32px">000</asp:TextBox></td>
                <td style="width: 60px; height: 12px;" align="center"><asp:TextBox ID="M3_txt" runat="server" Width="56px">0001222</asp:TextBox></td>
                <td style="width: 45px; height: 12px;" align="center">
                    &nbsp;</td>
                <td style="width: 300px; height: 12px;">&nbsp;</td>
            </tr>
            <tr>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 106px; height: 19px;">
                    &nbsp;</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 45px; height: 19px;" align="center" valign="top">
                    Country</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 40px; height: 19px;" align="center" valign="top">
                    Area</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 60px; height: 19px;" align="center" valign="top">
                    Phone No</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 45px; height: 19px;" align="center" valign="top">
                    &nbsp;</td>
                <td style="width: 300px; height: 19px;">&nbsp;</td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 107px;" align="left">
                    &nbsp;Fax No:</td>
                <td style="width: 45px" align="center"><asp:TextBox ID="F1_txt" runat="server" Width="40px">63</asp:TextBox></td>
                <td style="width: 40px" align="center"><asp:TextBox ID="F2_txt" runat="server" Width="32px">000</asp:TextBox></td>
                <td style="width: 60px" align="center"><asp:TextBox ID="F3_txt" runat="server" Width="56px">0001222</asp:TextBox></td>
                <td style="width: 45px" align="center"><asp:TextBox ID="F4_txt" runat="server" Width="40px">000123</asp:TextBox></td>
                <td style="width: 300px">&nbsp;</td>
            </tr>
            <tr>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 107px;">
                    &nbsp;</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 45px;" align="center" valign="top">
                    Country</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 40px;" align="center" valign="top">
                    Area</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 60px;" align="center" valign="top">
                    Phone No</td>
                <td style="font-size: 7pt; font-family: Verdana; color: #999999; width: 45px;" align="center" valign="top">
                    Ext</td>
                <td style="width: 300px">&nbsp;</td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>
        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 107px;" align="left">
                    &nbsp;Email:</td>
                <td style="width: 190px"><asp:TextBox ID="Email_txt" runat="server" Width="188px"></asp:TextBox></td>
                <td style="width: 150px" align="center"><asp:Button ID="Save_btn" runat="server" Text="Save" 
                    BackColor="Gainsboro" Font-Names="Verdana" Width="80px" /></td>
                <td style="width: 150px" align="center"><asp:Button ID="Cancel_btn" runat="server" Text="Cancel" 
                    BackColor="Gainsboro" Font-Names="Verdana" Width="80px" /></td>
            </tr>
            </table>
            
        </td></tr>
        <tr><td>        
            <table border="0" cellpadding="0" cellspacing="0" width="100%">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 110px; height: 3px;" align="left"></td>
            </tr>
            </table>
        </td></tr>        
        </table>             
    </td>
    <!-- End Content --></tr>
    
    </table>        

    <asp:ScriptManager ID="ScriptManager1" runat="server" />
        
</asp:Content>